Rheumatoid arthritis (RA) is a chronic, autoimmune disorder characterized by inflammation of the synovial joints, leading to joint damage and functional impairment. It is classified under the category of Bi Syndrome, or “Bi zheng (痹症)” in Traditional Chinese Medicine (TCM), where its pathogenesis is attributed to deficiencies in qi and blood, as well as liver and kidney insufficiency. These deficiencies make the body vulnerable to external pathogenic factors like wind and cold, resulting in meridian stagnation and pain. Over time, dampness, phlegm, and blood accumulate around the joints, exacerbating the blockage of qi and blood flow, complicating treatment. In this context, venomous animal-derived herbs (VH) are utilized for their potent effects in eliminating wind and invigorating blood compared to traditional plant herbs. VH includes medicinal insects, snakes, and worms.

In Western medicine, RA is understood as an autoimmune disease where the immune system erroneously attacks the synovial lining of joints, leading to inflammation, pain, and joint destruction. Common treatments involve disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate, biologics like TNF inhibitors, and nonsteroidal anti-inflammatory drugs (NSAIDs). Despite advancements, these treatments can have limitations and side effects, prompting interest in complementary therapies. Recent studies have explored the potential of integrating TCM practices, including VH, to enhance treatment outcomes.

Commonly used Venomous Animal-Derived Herbs and their standard dosages:

• Scorpion: Buthus martensii Karsch (全蝎): Poisonous, decoct 3-6g.
• Centipede: Scolopendra subspinipes mutilans L.Koch (蜈蚣): Poisonous, decoct 3-5g.
• Cantor’s Rat Snake: Zaocys dhumnades, Cantor (乌梢蛇): Non-poisonous, decoct 6-12g.
• Earthworm: Pheretima (地龙): Non-poisonous, decoct 5-10g.
• Five-Pacer Viper: Agkistrodon acutus, Guenther (蕲蛇): Poisonous, decoct 3-9g.
• Chinese Medicinal Roach: Eupolyphaga sinensis Walker or Steleophaga plancyi (土鳖虫): “Small poison,” decoct 3-10g.
• Silkworm: Bombyx Batryticatus (僵蚕): Non-poisonous, decoct 5-10g.

Research suggests that VH may offer benefits in treating RA, particularly when used alongside conventional Western treatments. An animal study demonstrated that combining VH with Western medication resulted in a significant reduction in inflammatory markers such as IL-6 and TNF-α compared to Western medication alone. Improved physical joint appearance and decreased joint inflammation and swelling were observed, indicating VH’s potential to mitigate joint damage and prevent bone erosion.

Several randomized controlled trials (RCTs) further support the use of VH in RA treatment. Adding TCM formulas containing VH to conventional therapies was associated with improved markers such as Erythrocyte Sedimentation Rate (ESR), C-reactive Protein (CRP), Disease Activity Score-28 (DAS-28), and American College of Rheumatology 20%/50%/70% improvement criteria (ACR20/50/70). Patients also reported reduced joint swelling, pain, movement difficulty, and morning stiffness. Notably, the incidence of adverse effects was comparable between VH and standard Western medicine.

While VH shows promise, the potential for toxicity necessitates caution. Many VH contain compounds that could be harmful, especially in high doses or with prolonged use. Most studies involving VH utilize them as part of complex TCM formulas, which may mitigate potential toxicity. Furthermore, the relatively short duration of treatment in many studies (2-6 months) may not fully capture long-term risks.

Recommendations for Safe Use of VH:

• Diversify VH Use: Rotate different VH in treatment plans to minimize toxin accumulation. For example, Buthus martensii Karsch can be alternated with Scolopendra subspinipes mutilans L. Koch, and Zaocys dhumnades with Agkistrodon acutus.
• Pair with Complementary Herbs: Combine VH with herbs that have yin and blood-nourishing properties to counterbalance their warming and drying effects.
• Adjust Dosages Individually: Tailor VH dosages based on individual patient profiles, particularly for those with a weaker constitution, alongside supportive herbs.
• Monitor Regularly: Conduct routine follow-ups with a rheumatologist to assess liver and kidney functions to detect potential adverse effects early.

In conclusion, integrating venomous animal-derived herbs into RA treatment protocols offers a promising complementary approach that aligns with both TCM and Western medicine principles. However, further research is required to establish long-term safety and efficacy, particularly in isolating VH effects from other components in TCM formulas.

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